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99mTc-HMPAO SPECT in the diagnosis of brain death

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Abstract

Objective

To evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD).

Design

Prospective study in comatose and brain-dead patients.

Setting

Neurologic ICU.

Patients and methods

Fifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD.

]Interventions

Brain SPECT following i.v. injection of 99mTc-HMPAO (300–1100 MBq), using a 4-headed gamma-camera (20 min, 360 °, 88 images).

Measurements and results

All patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7 %), clearly showing the arrest of brain perfusion (picture of “empty skull”); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later.

Conclusions

Our results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.

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Authors and Affiliations

  1. Lab. Neurophysiology - Neuro ICU, Dept. of Anesthesiology and Intensive Care, University of Padua, via C. Battisti 267, I-35121, Padova, Italy

    E. Facco, M. Munari, F. Baratto, A. U. Behr, A. Gerunda & G. Giron

  2. Nuclear Medicine Service I, University of Padua, via C. Battisti 267, 1-35121, Padova, Italy

    P. Zucchetta, M. Gregianin & F. Bui

  3. Dept. of Neurology, University of Padua, via C. Battisti 267, 1-35121, Padova, Italy

    M. Saladini

Authors
  1. E. Facco
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  2. P. Zucchetta
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  3. M. Munari
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  4. F. Baratto
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  5. A. U. Behr
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  6. M. Gregianin
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  7. A. Gerunda
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  8. F. Bui
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  9. M. Saladini
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  10. G. Giron
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Corresponding author

Correspondence to E. Facco.

Additional information

This study was partly supported by Regione del Veneto, Giunta Regionale — Ricerca Sanitaria Finalizzata — Venice, Italy

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Facco, E., Zucchetta, P., Munari, M. et al. 99mTc-HMPAO SPECT in the diagnosis of brain death. Intensive Care Med 24, 911–917 (1998). https://doi.org/10.1007/s001340050689

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  • DOI: https://doi.org/10.1007/s001340050689

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